Colonic ulcers in propylthiouracil induced vasculitis with secondary antiphospholipid syndrome

A 48 year old white woman was admitted to the hospital because of several bouts of migratory polyarthritis, weight loss, fever, and abdominal pain over a period of 15 months. She had been taking propylthiouracil 100 mg daily for three years for hyperthyroidism treatment. A test for antineutrophil cy...

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Bibliographic Details
Published in:Postgraduate medical journal 2005-05, Vol.81 (955), p.338-340
Main Authors: Gaburri, P D, Chebli, J M F, Attalla, Â, Pereira, C M N, Bonfante, H L, Martins Junior, E V, Gaburri, A K
Format: Article
Language:English
Subjects:
Abdomen
Adverse Drug Reaction
ANCA
Antibodies
Anticoagulants
antineutrophil cytoplasmic autoantibody
antiphospholipid syndrome
Antiphospholipid Syndrome - complications
Antithyroid Agents - adverse effects
Biological and medical sciences
Biopsy
Blood clots
colon
Colonic Diseases - chemically induced
Colonoscopy
Drug withdrawal
Drugs
Female
General aspects
Hemoglobin
Humans
Hyperthyroidism
Hyperthyroidism - drug therapy
Medical sciences
Middle Aged
propylthiouracil
Propylthiouracil - adverse effects
PTU
Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis
Thrombosis
Ulcer - chemically induced
Ulcers
vasculitides
Vasculitis - chemically induced
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Summary:A 48 year old white woman was admitted to the hospital because of several bouts of migratory polyarthritis, weight loss, fever, and abdominal pain over a period of 15 months. She had been taking propylthiouracil 100 mg daily for three years for hyperthyroidism treatment. A test for antineutrophil cytoplasmic autoantibodies (ANCA) was positive with a perinuclear pattern of staining. Antiphospholipid antibodies were also detected. Colonoscopy showed several ulcers on intestinal mucosa and the biopsy specimen showed intense microscopic vasculitis. The patient is well after methylprednisolone pulse therapy and eight months of oral azathioprine. A surveillance colonoscopy showed complete healing of intestinal ulcers. No recurrence of symptoms has occurred and autoantibodies are negative, 10 months after treatment finished. The sequence of events suggests a propylthiouracil induced vasculitis p-ANCA positive and an antiphospholipid syndrome. This is the first report of colonic ulcers diagnosed and successfully treated in such circumstances.
ISSN:0032-5473
1469-0756
DOI:10.1136/pgmj.2004.026104